I wouldn't be too concerned about program shut down. It hasn't even started, why would it shut down?
All new programs are placed on probation anyways as a rule and reviewed in 1-2 years. New programs don't have political inertia, and if we're talking about a small, private, unopposed community program, chances are the community and political powers will rally for the program and remove any barriers to RRC full accreditation. Plus, with new programs, the program director has a chance to put the major things into motion the way s/he envisions it. I can't imaging an imminent shut down, especially when the major pieces are probably taken care already prior to launch. And even then, they have opportunity to fix it.
RRC is not the fear. The fear is from funding. Many programs in the last 12 months have been shutting down because of the lost of funds. Bad economy, rising unemployment (and therefore more uninsured), lost of revenues, and the program shuts down. The fact that the program is looking to launch in 2010 means someone is either stupid or confident or both. I'm going to bet that things are ok. But if you have your doubts, ask the PD how the program makes money. When community hospitals become teaching hospitals, their Medicare reimbursement rates for ALL services go up (triple, I believe). So the hospital departments (like dialysis or cath lab) will get reimbursed at a higher rate than they would've been before, regardless of whether or not they are directly involved in resident education. So find out if the hospital will funnel those funds back into the residency program but more importantly, ask how existing patient volume/services rendered currently are and if they're projected to decrease, increase, stabilize. That will give you an idea how financially stable the hospital's line of money is.
2nd question to ask is whether or not you (as a resident) and de facto your residency program will be seeing insured patients. Because the program must make money. If all you're doing is seeing the uninsured, you will get dumped by all the private doctors in the community as the no-doc-no-pay providers and the cost will increase without concomittant increase in revenue. Private doctors in the community will cherry pick all the insured patients and leave the residents with the non-paying ones. At first, private docs will "help with the residency program", but over time, they get tired of that education crap and need to make frickin' money. If your residency isn't set up where it can keep the community private docs in check in the community by holding them where it hurts (i.e. their wallet), your program is destined for shut down.
3rd question to ask is, if FM clinic sees only/mostly the underserved (uninsured, cash-pay, Medicaid, and maybe county), are they designated as FHQC? FHQC's get reimbursed 3-5x Medicaid rates (I think), which is one way of making money for the clinic to keep it afloat. For some FHQC's, they lose money by seeing insured patients, and so they will sometimes not accept patients with insurance (as f'ed up as that sounds).
4th question to ask is what is the distribution of time faculty spends in clinic, precepting, teaching and doing research. Faculty can see more patients and do more procedures/operations than residents can and everytime they're not seeing patients, the program is not getting paid (unless they're working off a research grant). So, if you're program pushes faculty to see patients, you may not see them teach too much. And if you see them teach/research/admin all the damn time, they're not seeing patients. So it's a very fine balance that if not maintained can affect resident education one way or another.
If your program relies solely on the kind generous altruism of the members of the community via a cute little community foundation... FORGET IT. When the economy is bad, no one donates. And when the stock market is bad, the foundation is down... look for some cost cutting measures, like reduction in support staff, even laying off of faculty; not to mention zero reinvestment into the residency program to keep it current, if not ready for the future (such as EMR).
Key to a financially stable program is lots of money coming from lots of places: clinical care from a diversified portfolio of payers, community support via donations/foundation, research grants... such that if any one of these variables drop out, your program can still stay afloat.
No money. No mission.
less middle of the night calls for tylenol and a low glucose on labs.
